www.medenosrce.net/arhimed   arhimed(a-t>medenosrce.net   [21/04/2026 21:50:49] http://www.medenosrce.net/arhimed/poglej.asp?id=108 Zgodnje morfološke in funkcijske spremembe perifernih arterij pri bolnikih z ateroskleroticno boleznijo arterij spodnjih udov Avtor: Mirjam Golob, štud. med. Mojca Jensterle, štud. med. Mentor: prof. dr. Pavel Poredoš, dr. med. IZHODIŠCA. Ateroskleroza je kronicna in napredujoca bolezen arterijske stene. Njen nastanek in razvoj pospešujejo številni dejavniki tveganja. Najpogostejše klinicne pojavne oblike ateroskleroze so koronarna srcna bolezen, ateroskleroza možganskih arterij in periferna arterijska okluzivna bolezen spodnjih udov (PAOB). V najzgodnejši fazi aterogeneze naj bi prišlo do motenj v delovanju žilne stene (zmanjšana sposobnost razširitve perifernih arterij) in do zadebelitve notranjih plasti arterijske stene (intime-medie (IM)). Vedno vec je dokazov, da je ateroskleroza sistemska bolezen, zato lahko pri bolniku, ki ima doloceno pojavno obliko bolezni, upraviceno pricakujemo vsaj najzgodnejše spremembe v delovanju in sestavi žilne stene tudi v drugih odsekih arterijskega sistema. V zadnjem casu imamo na voljo ultrazvocne metode, s katerimi lahko sledimo in ugotavljamo te spremembe na povsem neinvazivni nacin. NAMEN IN HIPOTEZA. V naši raziskavi smo želeli ugotoviti, ali imajo bolniki z dokazano ateroskleroticno boleznijo spodnjih udov (PAOB) predklinicne morfološke in funkcijske spremembe v drugih odsekih arterijskega sistema. Preverjali smo naslednjo hipotezo: Bolniki s PAOB brez klinicnih znakov motenj možganskega krvnega obtoka imajo zaznavne predklinicne morfološke spremembe na karotidnih arterijah (CA) in endotelno disfunkcijo perifernih (brahialnih) arterij. METODE: V prospektivno raziskavo smo vkljucili 34 bolnikov, ki so imeli motnje arterijske prekrvitve spodnjih udov, stadij II po Fontainu, in klavdikacijsko razdaljo od 50 do 500 metrov (povprecno 250 ± 170 m), nobeden od sodelujocih bolnikov ni imel klinicnih znakov koronarne ali možganske ateroskleroze. Povprecno so bili stari 64 let (od 49 do 79). Kontrolno skupino je sestavljalo 30 zdravih preiskovancev povprecne starosti 64 let (od 54 do 76) in brez pomembnih dejavnikov tveganja za aterosklerozo. Preiskovanci kontrolne skupine so bili v osnovnih bioloških znacilnostih primerljivi z bolniki. Pri vseh preiskovancih smo merili debelino intime medie (DIM) in beležili prisotnost asimptomatskih ateroskleroticnih plakov v CA ter sposobnost razširitve brahialne arterije (BA) med povecanim krvnim pretokom (FMD) z dvodimenzionalno ultrazvocno preiskavo na nacin B. Razlike med skupinama smo ugotavljali s Studentovim t testom. REZULTATI. Pri bolnikih smo v primerjavi s preiskovanci iz kontrolne skupine ugotovili pomembno vecjo povprecno DIM preiskanih CA (0.8 ± 0.2 mm proti 0.6 ± 0.1 mm, p < 0.001) in znacilno vecje število asimptomatskih ateroskleroticnih plakov (20 proti 3, p < 0.001). DIM je bila pri bolnikih s PAOB znacilno povezana z indeksom telesne mase (ITM) (r = 0.37, p = 0.03), nakazovale pa so se tudi povezave med DIM in starostjo bolnikov, med DIM in trajanjem bolezni ter med prisotnostjo plakov in gleženjskim indeksom (GI). Bolniki s PAOB so imeli pomembno manjše povecanje premera BA med hiperemijo kot kontrolna skupina (7.2 ± 4.9 proti 12.3 ± 2.1%, p < 0.001). Na zmanjšanje od endotelija odvisne razširitve BA je najpomembneje vplivala prisotnost PAOB, nakazovala pa se je tudi povezava med FMD in ITM. ZAKLJUCKI. Ugotovili smo, da imajo bolniki s PAOB brez klinicnih znakov motenj možganskega krvnega obtoka zaznavne morfološke spremembe na CA (zadebeljeno IM in številcnejše asimptomatske ateroskleroticne lehe) glede na zdrave preiskovance in da imajo endotelno disfunkcijo neprizadetih perifernih arterij. Rezultati raziskave potrjujejo našo predpostavko, da je ateroskleroza generalizirana bolezen, pri kateri potekajo funkcijske in morfološke spremembe v razlicnih odsekih arterijskega sistema, ceprav ne povsod z enako mocjo. Spremljajoce ateroskleroticne spremembe v razlicnih organskih sistemih so verjetno eden od poglavitnih razlogov za povecano obolevnost in umrljivost bolnikov s PAOB. «» [Abstract / English version] Early morphological and functional changes in peripheral arteries of patients with atherosclerotic disease of lower limb arteries Author: Mirjam Golob, štud. med. Mojca Jensterle, štud. med. Mentor: prof. dr. Pavel Poredoš, dr. med. BACKGROUND. Atherosclerosis is a chronic, degenerative disease of arterial wall that is caused and aggravated by numerous risk factors. Coronary artery disease, central nervous system (CNS) arteries atherosclerosis and peripheral arteries occlusive disease (PAOD) of the lower limbs are the most common clinical manifestations of atheroslerosis. Early progression of atherosclerosis is characterised by dysfunction of endothelial cells (impaired vasodilatation of peripheral arteries) and by structural changes of arterial wall (thickening of the intima-media (IM)). There is a large amount of scientific data proving that nature of the disease is systemic. Therefore, in a patient diagnosed with one of the mentioned manifestations we can also expect other sections of arterial system to be impaired. These changes are presumably spread across majority of sections of the arterial system. We can study and follow them noninvasively by using new high-resolution ultrasound methods. AIM AND HYPOTHESIS. The aim of our research was to determine whether patients with diagnosed PAOD of lower limbs have any early subclinical functional or structural arterial wall disturbances in other sections of the arterial system. We tested the following hypothesis: PAOD patients without clinical signs of CNS arteries atherosclerosis have asymptomatic morphological changes in carotid arteries (CA) and endothelial dysfunction of peripheral (brachial) arteries. METHODS. Our group consisted of 34 patients with arterial perfusion disturbances in Fontaine stage II and claudication distance of 50 to 500 meters (average 250 ± 170 m). Patients were without any clinical signs of either coronary or CNS arteries atherosclerosis. Their mean age was 64 years (from 49 to 79). Control group consisted of 30 healthy volunteers with mean age 64 years (from 54 to 76) without major risk factors for atherosclerosis. Basic biological properties were comparable among the groups. In all subjects intima-media thickness (IMT), presence of asymptomatic atherosclerotic plaques in CA and brachial artery (BA) dilatation during reactive hyperaemia were measured using B mode ultrasound technique. Differences between groups were tested using Student t test. RESULTS. IMT was significantly increased in all sections of CA compared to control (0.8 ± 0.2 mm against 0.6 ± 0.1 mm, p < 0.001). Number of asymptomatic atherosclerotic CA plaques was also significantly increased compared to control (20 against 3, p < 0.001). There was significant correlation between IMT and BMI of PAOD patients (r = 0.37, p = 0.03). IMT and patient age, IMT and time from clinically diagnosed disease, ankle-brachial index (ABI) and presence of arterial plaques all showed some correlation, however not significant. During reactive hyperaemia, PAOD patients had significantly lower BA dilatation compared to the control group (7.2 ± 4.9 % against 12.3 ± 2.1 %, p< 0.001). PAOD was the most important independent factor influencing the low BA dilatation during reactive hyperaemia. There was some correlation between BA diameter and IMT, however not significant. CONCLUSIONS. From our results we can show that patients with PAOD without clinical signs of CNS arteries atherosclerosis have morphological changes on CA (increased thickness of IM and numerous asymptomatic atherosclerotic plaques). Furthermore, they also have endothelial dysfunction in peripheral arterial system. By showing this, we proved out hypothesis that atherosclerosis is a generalised disease, leading to functional and structural changes in various sections of arterial system, eventhough not everywhere with same intensity. Concurrent atherosclerotic changes in various organ systems are most probably one of the main reasons leading to increased morbidity and mortality of patients with PAOD.